<!DOCTYPE html>
<html lang="en">
	<head>
	  	<meta charset="UTF-8">
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	    <meta http-equiv="X-UA-Compatible" content="IE=edge,chrome=1">
	    <meta name="viewport" content="width=device-width, initial-scale=1, maximum-scale=1">
	    <title>建新街道移动办公 - E事通</title>
	    <link rel="stylesheet" href="/app/static/layui/css/layui.css">
	    <link rel="stylesheet" href="/app/static/styles/style.css">
	    <link rel="icon" href="image/code.png">
	    <script src="/app/static/scripts/jquery-1.9.1.js"></script>
	    <script type="text/javascript" src="/app/static//layui/layui.all.js"></script>
		<script type="text/javascript" src="/app/static/scripts/index.js"></script>
	</head>

	<body class="body">
		
		<a href="javascript:history.go(-1);" class="layui-btn">返回</a>	
		<form class="layui-form layui-form-labelw100" style="width: 500px;margin-top: 30px;">
			<div class="layui-form-item">
				<label class="layui-form-label"><i class="must_star">*</i>办理事项</label>
				<div class="layui-input-block">
					<select>
				        <option value="">矛盾调解</option>
				        <option value="0">计生</option>
			      	</select>
				</div>
			</div>	
			<div class="layui-form-item">
				<label class="layui-form-label"><i class="must_star">*</i>办理类型</label>
				<div class="layui-input-block">
					<select>
				        <option value="">即办件</option>
				        <option value="0">交办件</option>
				        <option value="1">居办件</option>
			      	</select>
				</div>
			</div>	
			<div style="height: 30px;background-color: #f2f2f2;line-height: 30px;text-align: center;margin-bottom: 10px;">群众诉求</div>
			<div class="layui-form-item">
				<label class="layui-form-label"><i class="must_star">*</i>反映人</label>
				<div class="layui-input-block">
					<input type="text" required lay-verify="required" placeholder="" class="layui-input">
				</div>
			</div>
			<div class="layui-form-item">
				<label class="layui-form-label"><i class="must_star">*</i>性别</label>
				<div class="layui-input-block">
					<input type="radio" name="sex" value="男" title="男">
     			 	<input type="radio" name="sex" value="女" title="女" checked>
				</div>
			</div>
			<div class="layui-form-item">
				<label class="layui-form-label"><i class="must_star">*</i>出生年月</label>
				<div class="layui-input-block">
					<input type="text" id="birth" required lay-verify="required" placeholder="" class="layui-input">
				</div>
			</div>
			<div class="layui-form-item">
				<label class="layui-form-label"><i class="must_star">*</i>所在网格</label>
				<div class="layui-input-block">
					<select>
				        <option value="0">第一网格</option>
				        <option value="1">第二网格</option>
				        <option value="2">第三网格</option>
				        <option value="3">第四网格</option>
			      	</select>
				</div>
			</div>	
			<div class="layui-form-item">
				<label class="layui-form-label"><i class="must_star">*</i>联系电话</label>
				<div class="layui-input-block">
					<input type="text" required lay-verify="required" placeholder="" class="layui-input">
				</div>
			</div>
			<div class="layui-form-item">
				<label class="layui-form-label"><i class="must_star">*</i>政治面貌</label>
				<div class="layui-input-block">
					<input type="text" required lay-verify="required" placeholder="" class="layui-input">
				</div>
			</div>
			<div class="layui-form-item">
				<label class="layui-form-label"><i class="must_star">*</i>家庭住址</label>
				<div class="layui-input-block">
					<input type="text" required lay-verify="required" placeholder="" class="layui-input">
				</div>
			</div>
			<div class="layui-form-item">
				<label class="layui-form-label"><i class="must_star">*</i>问题描述</label>
				<div class="layui-input-block">
					<textarea name="desc" placeholder="" class="layui-textarea"></textarea>
				</div>
			</div>
			<div style="height: 30px;background-color: #f2f2f2;line-height: 30px;text-align: center;margin-bottom: 10px;">事项处理</div>
			<div class="layui-form-item">
				<label class="layui-form-label"><i class="must_star">*</i>社工姓名</label>
				<div class="layui-input-block">
					<input type="text" required lay-verify="required" placeholder="" class="layui-input">
				</div>
			</div>
			<div class="layui-form-item">
				<label class="layui-form-label"><i class="must_star">*</i>办理进度</label>
				<div class="layui-input-block">
					<input type="radio" name="progress" value="待办" title="待办">
     			 	<input type="radio" name="progress" value="在办" title="在办">
     			 	<input type="radio" name="progress" value="办结" title="办结">
				</div>
			</div>
			<div class="layui-form-item">
				<label class="layui-form-label"><i class="must_star">*</i>办理提醒时间</label>
				<div class="layui-input-block">
					<input type="text" id="remindTime" required lay-verify="required" placeholder="" class="layui-input">
				</div>
			</div>
			<div class="layui-form-item">
				<label class="layui-form-label"><i class="must_star">*</i>满意度</label>
				<div class="layui-input-block">
					<input type="radio" name="satisfy" value="满意" title="满意">
     			 	<input type="radio" name="satisfy" value="不满意" title="不满意">
				</div>
			</div>
			
			
			
			<div class="layui-form-item">
				<div class="layui-input-block">
					<button type="reset" class="layui-btn layui-btn-primary">取消</button>
					<button class="layui-btn" lay-submit>提交</button>
				</div>
			</div>
		</form>
		
		
		
	
		<script type="text/javascript">
			var form = layui.form,
				layer = layui.layer,
				layedit = layui.layedit,
				laydate = layui.laydate;
				
				form.render()
				
			laydate.render({
			    elem: '#birth' //指定元素
			});

			laydate.render({
			    elem: '#remindTime' //指定元素
			});
		</script>
	</body>

</html>